A prospective cohort study characterising patients declined emergency laparotomy: survival in the ‘NoLap’ population

Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P‐POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow‐up was 1.3 (0.1–1.8 [0.0–2.5]) years for the cohort, 1.5 (1.1–2.0 [0.0–2.6]) years after laparotomy and 0.0 (0.0–1.1 [0.0–2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow‐up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6–21 [0–49]) and 4 (2–6 [0–36]) years, respectively, p < 0.0001. ‘Poor fitness’ precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients

Integrated Pest Management of Texas Turfgrass.

26 p

Intrapreneurial self-capital training: a case study of an Italian university student

This chapter presents a case study which describes the application of the Intrapreneurial Self-Capital Training with a final-year postgraduate female biology student, Erica. The chapter presents an overview of theory that is relevant to the world of work and the conceptual dimensions of intrapreneurial self capital (ISC). Training for ISC aims to assist young people to identify their personal strengths in terms of intrapreneurship and career adaptability. A qualitative instrument, the Life Adaptability Qualitative Assessment (LAQuA) was administered before and after the training to detect meaningful changes in the participant’s narratives about career adaptability and enhanced reflexivity. The LAQuA coding system revealed enhancements to the participant’s awareness about her personal intrapreneurial resources and career adaptability. The relevance of ISC to employability and career services in education contexts is discussed along with recommendations for research into ISC training

Are community forestry principles at work in Ontario’s County, Municipal, and Conservation Authority forests?

Ontario’s County, Municipal and Conservation Authority forests have received little attention within the academic literature on community forestry in Canada. These “Agreement Forests”, as they were once called, are a product of the early 20th century and have been under local government management since the 1990s. Most are situated in Southern Ontario. In this article we investigate the extent to which community forestry principles are at work in these forests. Three principles—participatory governance, local benefits and multiple forest use—are analyzed using a composite score approach derived from survey data collected from nearly all of these forest organizations (response rate = 80%). Results indicate that most of these organizations do display attributes associated with community forestry principles, including a local governance process, public participation activities, local employment and multiple-use management. Traditional forestry employment is less strong than in similar studies of Crown land community forests; however, there is an important emphasis on non-timber activities. The article concludes that the County, Municipal and Conservation Authority forests represents a unique approach, which reflects the specific geographic and socio-economic context in which it resides. / Les forêts cantonales, municipales et des offices de conservation de l’Ontario n’ont reçu qu’une faible couverture dans la littérature scientifique sur la foresterie communautaire au Canada. Ces « forêts d’entente (Agreement Forests) », comme on les appelait avant, ont été créées au début du XXe siècle et gérées par les autorités locales depuis les années 1990. La majeure partie de ces forêts sont situées dans le sud de l’Ontario. Dans cet article, nous cherchons à voir jusqu’à quel point les principes de foresterie communautaire sont mis en application dans ces forêts. L’étude porte sur trois principes – la gouvernance participative, les bénéfices locaux et l’utilisation polyvalente de la forêt – qui furent analysés avec l’approche de résultats combinés utilisant les données d’un sondage effectué auprès de presque toutes ces organisations forestières (taux de réponse = 80 %). Les résultats indiquent que la plupart de ces organisations présentent effectivement certains attributs rappelant les principes de la foresterie communautaire, incluant un processus de gouvernance locale, des activités de participation du public, l’embauche locale et l’aménagement à des fins d’utilisation polyvalente. Les emplois forestiers traditionnels ont moins d’importance que dans les études similaires des forêts communautaires établies sur des terres publiques; par contre, on accorde beaucoup d’importance aux activités sans prélèvement de bois. L’article conclut que les forêts cantonales, municipales et des offices de conservation constituent une approche unique qui reflète bien le contexte géographique et socio-économique spécifique dans lequel elles sont établies.Financial support from the Fonds québécois de la recherché sur la société et la culture and the Social Sciences and Humanities Research Council.http://pubs.cif-ifc.org/doi/10.5558/tfc2012-13

Expatriation and Incapacity created by a Multitude of Hidden Inequalities

The ability of UK based Academics to function within collaborative partnerships is becoming an important part of the UK Universities internationalisation agenda. This chapter offers an auto-ethnographical academic expatriate experience detailing some of the challenges faced when moving to work in a ‘UK environment positioned abroad’, specifically in China. It will provide HR personnel with alternative understandings of possible support strategies that could assist individuals in dealing with a variety of hidden inequalities that surface. These hidden inequalities can contribute to a possible shortening of the assignment due to cultural contexts in which they are operating (Foster 1997; Wang and Varma 2017)

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

My Career Chapter: Guidance Counsellors' Appraisal of its Suitability for Adolescents

This paper presents an investigation into the properties of a new narrative technique for career assessment and counselling, My Career Chapter: A Dialogical Autobiography. This technique is used to facilitate clients' construction of a meaningful career-related autobiography. Previous research indicates the usefulness of My Career Chapter for adult clients and its alignment with recommendations for the development and application of qualitative assessment and counselling techniques. This study specifically commences research into the technique's applicability for adolescents. A focus group, comprised of guidance counselling professionals whose work primarily pertained to the needs of adolescents, found that there is potential to develop a version of My Career Chapter that is suitable for adolescents